| Tenacious Resilient Individual Living In Focused Energy Wellness | |
|
19 Sexton St New Britain CT 06051-1017 | |
| (860) 916-0801 | |
| Not Available |
| Full Name | Tenacious Resilient Individual Living In Focused Energy Wellness |
|---|---|
| Speciality | Clinic/Center |
| Location | 19 Sexton St, New Britain, Connecticut |
| Authorized Official Name and Position | Manuel Sandoval (OWNER) |
| Authorized Official Contact | 8609160801 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tenacious Resilient Individual Living In Focused Energy Wellness 19 Sexton St New Britain CT 06051-1017 Ph: () - | Tenacious Resilient Individual Living In Focused Energy Wellness 19 Sexton St New Britain CT 06051-1017 Ph: (860) 916-0801 |
| NPI Number | 1104503879 |
|---|---|
| Provider Enumeration Date | 07/03/2023 |
| Last Update Date | 12/05/2024 |
| Certification Date | 11/14/2024 |
| Medicare PECOS PAC ID | 5395278303 |
|---|---|
| Medicare Enrollment ID | O20241030000160 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104503879 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Manuel A Sandoval |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437743903 PECOS PAC ID: 2769852854 Enrollment ID: I20230106000232 |
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